Kaizen in the Emergency Department - SSM Health Care

Kaizen in the
Emergency Department
St. Mary’s Health Center
Jefferson City, Missouri
What is Kaizen
• A Japanese word
meaning incremental
continuous
improvement which
involves crossfunctional
teams
working together.
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Kaizen Principles
• Don’t worry about being perfect – Start now
• If something is wrong, fix it on the spot
• Ask “Why” 5 times to get to the root cause
• Say “No” to status quo
• Look for wisdom from ten people rather than
one
• Never stop doing Kaizen
Kaizen Expectations
• Observe with your own eyes
• Identify and eliminate waste
• Take action to improve a process or product
• Focus on results – Not talk!
• 20% learning – 80% doing
2

Planning
• Begins 6 weeks out
• Choose area for event
• Collect baseline data / analysis
• Develop charter
• Select cross-functional team members
• Assist with logistics/resource issues
Planning Event Follow Up
Master Checklist
Kaizen Preparation
6 weeks prior 5 weeks prior 4 weeks prior 3 weeks prior 2 weeks prior 1 week prior During 1 week after
• Schedule initial • Hold initial meeting • Meet with core team • If necessary, notify • With core team • Order refreshments • Team members • Hold a follow up
meeting with Process with Process Owner and do process walk the union of Kaizen plan education for event week Sign off on charter meeting with team to
Owner
schedule and event agenda.
critique Kaizen event
week activities
• Schedule initial • Hold initial area • Identify Kaizen team ∴ • Core team meets 1- • Verify room
• Hold daily and • Complete all Kaizen
area evaluation with evaluation with members
on-1 with Kaizen team
final report out forms including a onepage
area managers managers, including
members
meetings and
summary of
process walk
celebration
improvements and
lessons learned
• Schedule Kaizen • Contract with area • Set Kaizen agenda • Invite Kaizen • Create area layout • Gather supplies • Schedule followup
• Review open Kaizen
meeting room managers regarding
members in person or – make wall chart (easels, pens, pencils,
walk through with newspaper items with
their responsibilities
by phone
forms, clipboards, etc. all parties
Process Owner
• Identify opportune • Write draft Kaizen
process
charter
• Identify team • Send invitations for
members
kick off, report-outs
and training days
• Schedule core team • Inform facilities and
member process walk other needed
resources so they can
prepare for the Kaizen
• Begin Kaizen
communication plan
• Confirm Kaizen team
members
• Core team review
and sign charter;
confirm agenda;
name sub-team
members and leaders
if necessary
• Agree on
assignments for room
setup
• Hold management
briefing
• Schedule a follow
up meeting for the
week after the Kaizen
• Invite Kaizen team
to follow-up walk
through and meeting
• Make certain
Kaizen Newspaper
“to do” tasks are
assigned
• Invite core team to
process walk
3

Kaizen – The Process
• Measure current
performance
• Identify and eliminate
waste
• Map things “as they are”
using Value Stream
Mapping
• Flow Value-Added
activities
• Brainstorm and
implement improvements
• Train employees in new
process
• Test changes
• Measure again
• Put in controls to sustain
gains
• Present and celebrate the
accomplishments!
Agenda
• Day 1
• AM – Training – Overview, 8 Wastes, 5s
• PM – “Field Trip”
• Day 2
• AM – Training – Process Exploration
• PM – Construct Value Stream Map
• Day 3
• AM – Observations and Training – 5 Whys
• PM - Brainstorming
4

The Eight Wastes
Wastes
Overproduction
Excess Inventory
Waiting
Transportation
Motion
Making Defects
Over-processing
Human Intellect
The simple explanation…
Doing more than you need to –
Output of a process
Keeping stuff on-hand when it
isn’t required
Things just don’t happen when
they should
Shipping stuff to
different locations
Excess movementperson/material
– Within
a process
It just doesn’t
meet expectations
Doing more than you need to –
Within a process
Not including the input of those people
most directly involved in the process
5S Steps
1. SORT Clearly distinguish what is needed and what
is not. Remove what does not support the
Least Waste Way
2. STRAIGHTEN Organize the way things are kept, making it
easier for anyone to find and return items to
their proper location in the sequence used.
Mark/label locations clearly
3. SHINE Keep things clean – Floors, machines, desks,
files, equipment – Neat and tidy
4. STANDARDIZE Maintain and improve the first 3S’s. “What
Causes Deterioration”
5. SUSTAIN Achieve the discipline/habit of properly
maintaining the correct procedures
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Agenda
• Day 1
• AM – Training – Overview, 8 Wastes, 5s
• PM – “Field Trip”
• Day 2
• AM – Training – Process Exploration
• PM – Construct Value Stream Map
• Day 3
• AM – Observations and Training – 5 Whys
• PM - Brainstorming
6

Transform Current State to
Ideal Future State
Education
Obstacle
Patient
registers
BVA
New
XWait in
waiting
area
NVA
Cycle time =
5 min
Complete
Queue = 1
paperwork
patient Cycle time =
BVA 20 min
Queue = 5
Pain Pt
patients
Proactive
paperwork
Go to room
XWait in
room
NVA
BVA
Scheduling
Cycle time =
7 min
Queue = 3
patients
Nurse
assessment
VA
Physician
assessment
VA
Bottle
neck
Agenda
• Day 1
• AM – Training – Overview, 8 Wastes, 5s
• PM – “Field Trip”
• Day 2
• AM – Training – Process Exploration
• PM – Construct Value Stream Map
• Day 3
• AM – Observations and Training – 5 Whys
• PM - Brainstorming
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Worklist
Item
Responsible
Parties Disposition Comments Next Steps
Place work request for hook for patient
belonging bags Bev Complete
Run query to determine % of JCMG patients
that come through ER
Sherrill
Train charge nurses / access for medication Brian / Sherrill /
records for JCMG patients
MB
Set up time(s) for training
Procure rack / document box for triage Jeff Complete
Trial supply cart from ICU
In process
Make changes to green sheet Bev Complete Follow up weekly for comments
Procure bubble for hall across from Reg
desk (determine cost) Norb Complete
Cut wall down to make shelf at Reg desk
During renovation meeting
Signage / instructions for green sheet Bev To contact Sue Evans Fax info to Bee Seen for quote
Move file cabinet in Reg under counter MB / Norb Complete
Move label printer from Triage to Reg Sherrill Complete
Move copier from Reg to Annex Sherrill Complete
Move small copier from Annex to Triage Sherrill Complete
Find horizontal space in Reg Temporarily accomplished Determine more permanent solution
Procure glove brackets Chris When will these be installed
Laminate visitor passes Bev Group to discuss
Set up meeting to discuss layout
construction Jim Set up for 2/16 @2:30 PM PDR
Agenda continued
• Day 4
• AM – Assess and Change
• PM – Report out to AC
• Day 5
• AM – Assess and Change
• PM – Celebrate
Success!!!
8

Results
• JCMG Medication list sharing
• Supply organization (Reduction in wait time)
• Reduction in Registration walk time (Savings of
8.1 hrs / month) – one move
• Reduction in wasted Admission Packets (Savings
of $ 380 / month)
• Layout changes for future
• Staff education
Results
Summary for Present/Physician Wait
A nderson-Darling Normality Test
A -Squared 62.41
P-Value < 0.005
Mean 23.951
StDev 22.127
V ariance 489.602
Skew ness 2.6641
Kurtosis 10.7419
N 995
0
30
60
90
120
150
180
210
Minimum 0.000
1st Q uartile 10.000
Median 17.000
3rd Q uartile 29.000
Maximum 209.000
95% C onfidence Interv al for Mean
22.574 25.327
95% C onfidence Interv al for Median
17.000 19.000
95% Confidence Intervals
95% C onfidence Interv al for StDev
21.196 23.144
Mean
Median
16
18
20
22
24
26
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Pros and Cons
• Delivers quick changes
• Imparts change culture
• Delivers training to
front-line staff
• Uncovers flow issues
• Flushes out larger
projects
• Limited in scope
• Tight timeframe
• Resource intense
• Requires carefully
monitored follow up
Questions
Jim Spratt
CQI Director
St. Mary’s Health Center
(573) 761-2195
Jim_Spratt@SSMHC.com
Beth Eidson
Administrative Director
Emergency Department
St. Mary’s Health Center
(573) 761-7007
Beth_Eidson@SSMHC.com
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